Request for Burial Detail

REQUEST FOR BURIAL DETAIL IF MISSION IS OFF THE ISLAND OF OAHU, TYPE AN ‘ X’ BELOW

PALAU ( ) MOLOKAI ( ) GUAM ( ) LANAI ( ) HAWAII ( ) RETIREE ( ) CASKET ( ) MEDAL OF HONOR ( ) URN ( ) VETERAN ( ) ACTIVE DUTY ( )

FIRING PARTY ( ) FLAG PRESENTER ( ) MILITARY CHAPLAIN ( ) FLAG PRESENTER ( ) PALL BEARER ( ) RELIGIOUS FLAG FOLDER ( )

URN BEARER ( ) DENOMINATION BUGLER ( ) BUGLER ( )

NAME OF DECEASED______LAST FIRST M

SSN/SERVICE NO: ______RANK/GRADE: __ _ __

ENLISTMENT DATE: ______DISCHARGE DATE: ______

PLACE OF SERVICE: ____

DATE OF SERVICE: ______DAY OF WEEK: ____ _ TIME: ______

FUNERAL HOME/ CEMETERY REQUESTING HONORS: ______

NAME OF INDIVIDUAL SENDING REQUEST: ______

PHONE: ______FAX PHONE: ______

PERSON HONOR GUARD IS TO CONTACT:

REMARKS/SPECIAL ORDERS: ______

*NOTES : PLEASE FURNISH MILITARY DISCHARGE DOCUMENTS WITH THIS REQUEST. THIS DOCUMENT MUST BE TYPED. POINT OF CONTACT IS CASUALTY AND MORTUARY AFFAIRS AT: PHONE: 655-5261/1200/1199 FAX: 655-8302 CASUALTY OFFICE USE ONLY

CAC RECEIVED REQUEST: SIGNATURE/ DTG______BAND RECEIVED REQUEST: SIGNATURE / DTG______

[BURIAL DETAIL NCOIC RECEIVED REQUEST] ______/______/______/______(RANK) (PRINT YOUR NAME) (SIGNATURE) (DATE/TIME) ******************************** MILITARY USE ONLY ********************************************** BDE OPS NCOIC RECEIVED REQUEST: SIGNATURE / DTG______

BN OPS NCOIC RECEIVED REQUEST: SIGNATURE / DTG______CONFIRMATION WITH: FUNERAL HOME/CEMETERY: YES: ( ) NO: ( ) DETAIL NCOIC:______(DATE/TIME)